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Resident and attending perceptions of direct observation in internal medicine: a qualitative study

机译：居民和参观内科直接观察的看法：定性研究

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Objectives Direct observation is the foundation of assessment and learning in competency‐based medical education ( CBME ). Despite its importance, there is significant uncertainty about how to effectively implement frequent and high‐quality direct observation. This is particularly true in specialties where observation of non‐procedural skills is highly valued and presents unique challenges. It is therefore important to understand perceptions of direct observation to ensure successful acceptance and implementation. In this study, we explored perceptions of direct observation in internal medicine. Methods We interviewed internal medicine attending physicians ( n ?=?9) and residents ( n ?=?8) at the University of Toronto, purposively sampled for diversity. Using a constructivist grounded theory approach, constant comparative analysis was performed to develop a framework to understand perceptions of direct observation on the clinical teaching units. Results Participants articulated a narrow perception of what constitutes direct observation, in contrast to their own descriptions of skills that were observed. This resulted in the perception that certain valuable skills that participants felt were routinely observed were nonetheless not ‘directly observable’, such as clinical reasoning, observed through case presentations and patient care discussions. Differentiating direct observation from informal observation led to overestimation of the time and resource requirements needed to enhance direct observation, which contributed to scepticism and lack of engagement related to CBME implementation. Conclusions In an internal medicine training programme, perceptions of what constitutes direct observation can lead to under‐recognition and hinder acceptance in workplace‐based assessment and learning. Our results suggest a reframing of ‘direct observation’ for residents and attending physicians, by explicitly identifying desired skills in non‐procedurally‐based specialties. These findings may help CBME ‐based training programmes improve the process of direct observation, leading to enhanced assessment and learning.
机译：目的直接观察是基于能力的医学教育（CBME）的评估和学习的基础。尽管重要的是，有关如何有效实施频繁和高质量的直接观察，具有重要的不确定性。在专业中，这尤其如此，观察非程序技能受到高度重视并提出独特的挑战。因此，了解对直接观察的看法，以确保成功接受和实施是很重要的。在这项研究中，我们探讨了内科直接观察的看法。方法采访了在多伦多大学的医生（n？= 9）和居民（n？=？8）的内科，有意地对多样性进行了采样。使用建构主义接地理论方法，进行持续的比较分析，以制定框架，以了解对临床教学单元的直接观察的看法。结果参与者阐明了对既有直接观察的狭隘感知，与观察到的技能描述相反。这导致了对参与者常规观察到的某些有价值的技能的看法是不是“直接观察”，例如通过案例演示和患者护理讨论观察到的临床推理。从非正式观察中区分直接观察导致高估了加强直接观察所需的时间和资源要求，这导致持怀疑主义和缺乏与CBME实施相关的参与。结论在内部医学培训方案中，对造成直接观察的内容的看法可能导致在基于工作场所的评估和学习方面承认和阻碍接受。我们的结果表明，通过明确地识别基于非程序的专业的所需技能，对居民和主持医生进行“直接观察”恢复“直接观察”。这些发现可能有助于CBME的培训计划改善直接观察过程，从而提高评估和学习。

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